Robot-Assisted Intraoperative Ultrasound in Retroperitoneal Lymphadenectomy: A Case Report

A definitive diagnosis of retroperitoneal lymph nodes and indeterminate lesions remains challenging because of the anatomical constraints limiting percutaneous biopsy approaches.This paper reports a case of a 75-year-old woman with monoclonal gammopathy of undetermined significance (MGUS) and a newly detected suspicious retroperitoneal lymph node on fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography ( 18 F-FDG PET/CT).Conventional ultrasound-and CT-guided biopsy was not feasible because of the proximity of the lesion to the right common iliac vein and lumbar spine.The patient underwent robotic-assisted extirpation of the lymph node using the DaVinci Xi system combined with intraoperative ultrasound guidance using the BK5000 ultrasound system and the Rob12C4 Robotic Drop-In transducer.The procedure was completed without complications, and adequate tissue was obtained for histopathological analysis, confirming the diagnosis of follicular lymphoma.The patient recovered uneventfully and was discharged on postoperative day one.This case shows that robotic-assisted intraoperative ultrasound is a safe and effective diagnostic modality, offering precise localization and minimally invasive access to retroperitoneal structures.